| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $7 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $10 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $23 | $26 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $13 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $14 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $13 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $80 | $734 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $80 | $859 | $2,072 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $80 | $537 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $80 | $342 | $518 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $80 | $671 | $1,184 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $80 | $792 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $42 | $781 | $2,220 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $42 | $395 | $814 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $80 | $891 | $1,628 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $42 | $485 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $80 | $882 | $1,924 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $80 | $904 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $80 | $1,466 | $4,500 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $644 | $782 | $920 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,118 | $1,118 | $1,118 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,310 | $2,310 | $2,310 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,716 | $2,815 | $2,915 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,028 | $3,028 | $3,028 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $719 | $719 | $719 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $678 | $842 | $1,051 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $20 | $23 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $10 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $12 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $98 | $116 | $129 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $49 | $49 | $49 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $88 | $119 | $153 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $132 | $160 | $216 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $111 | $165 | $219 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $85 | $331 | $537 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $140 | $230 | $284 |
| Stress echocardiography CPT 93350 • Cardiology | $124 | $218 | $308 |
| Left and right heart catheterization CPT 93452 • Cardiology | $339 | $583 | $826 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $944 | $1,367 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $470 | $914 | $1,359 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $242 | $290 | $337 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $85 | $115 | $149 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $53 | $125 | $255 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $183 | $234 | $329 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $20 | $47 | $75 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $69 | $69 | $69 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $33 | $103 | $157 |